Outpatient Satisfaction Survey

 
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SURVEY INSTRUCTIONS

  • Complete this survey only if you received services in the Laboratory and/or Radiology departments.

  • Answer all of the questions by selecting the button to the left of your answer.

 
Registration
1. Was the registration easy to complete?
2. Was the manner of the person who registered you courteous, respectful, and sensitive?
3. Was the waiting time before you were called to your outpatient service appropriate?
Environment
4. Was the area clean and free of clutter?
5. Was the equipment in working order?
6. Was the noise level in the area kept to a minimum?
7. Was the room temperature comfortable?
Services
8. Was the manner of the staff courteous, respectful, and sensitive?
9. Was the staff thorough, careful, and knowledgeable in their performance of the procedure?
Overall Rating of Hospital
Please answer the following questions about your stay at Pointe Coupee General Hospital. Do not include any other hospital stays in your answers.
10. Using any number 0 to 10, where 0 is the worst hospital possible and 10 the best hospital possible, what number would you use to rate this hospital during your visit?
11. Would you recommend this hospital to your friends and family?
About You
12. In general, how would you rate your overall health?
13. What is the highest grade or level of school that you have completed?
14. Are you of Spanish, Hispanic, or Latino origin or descent?
15. What is your race?
Please choose one or more.
16. What language do you mainly speak at home?
 

Source: www.hcahpsonline.org
Centers for Medicare and Medicaid Services
Baltimore, MD
June 26, 2011